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神经科学与养育相遇:早产儿面临的挑战以及以家庭为中心和发展性护理的关键作用,作为神经保护护理包的重要组成部分。

Neuroscience meets nurture: challenges of prematurity and the critical role of family-centred and developmental care as a key part of the neuroprotection care bundle.

机构信息

Neonatology, Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar

Department of Neonatology, Mediclinic Parkview Hospital, Dubai, UAE.

出版信息

Arch Dis Child Fetal Neonatal Ed. 2022 May;107(3):242-249. doi: 10.1136/archdischild-2020-319450. Epub 2021 May 10.

Abstract

Advances in neonatal-perinatal medicine have resulted in increased survival at lower gestations. Although the incidence of germinal matrix haemorrhage-intraventricular haemorrhage and cystic periventricular leucomalacia is reducing, a new phenotype of preterm brain injury has emerged consisting of a combination of destructive and dysmaturational effects. Consequently, severe neurological disability is reported at a lower rate than previously, but the overall morbidity associated with premature birth continues to present a large global burden and contributes significantly to increased financial costs to health systems and families. In this review, we examine the developmental milestones of fetal brain development and how preterm birth can disrupt this trajectory. We review common morbidities associated with premature birth today. Although drug-based and cell-based neuroprotective therapies for the preterm brain are under intense study, we outline basic, sustainable and effective non-medical, family-centred and developmental care strategies which have the potential to improve neurodevelopmental outcomes for this population and need to be considered part of the future neuroprotection care bundle.

摘要

新生儿围产医学的进步使得更低胎龄的婴儿存活率提高。尽管脑室内出血和囊性脑白质软化症的发病率在降低,但一种新的早产儿脑损伤表型已经出现,其特征是破坏性和不成熟性的综合作用。因此,严重的神经发育障碍的报告率比以前低,但与早产相关的整体发病率仍然给全球带来了巨大的负担,并显著增加了卫生系统和家庭的经济成本。在这篇综述中,我们检查了胎儿大脑发育的发育里程碑,以及早产如何干扰这一过程。我们回顾了与早产相关的常见并发症。虽然针对早产儿脑的药物和细胞神经保护疗法正在深入研究,但我们概述了基本的、可持续的和有效的非医学、以家庭为中心和发展性护理策略,这些策略有可能改善这一人群的神经发育结果,需要被视为未来神经保护护理方案的一部分。

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